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General NPI Number Information
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NPI Number | 1609557057
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Entity Type | Individual
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Provider Name | MEGAN KLEINERT FAIRBAIRN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 110 HARDYVILLE CIR
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City | DEMOREST
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State | GA
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Zip | 30535-6007
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Country | US
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Telephone | 706-778-6260
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Fax |
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Provider Business Mailing Address
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Address Line | 170 THOMAS ST APT D
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City | CORNELIA
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State | GA
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Zip | 30531-3638
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Country | US
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Telephone | 706-968-2168
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123177
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License Number State | GA
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